Abstract

BackgroundGood hand hygiene (HH) practice is crucial to reducing healthcare associated infections (HAIs). Use of alcohol-based hand rub (ABHR) at health facilities is strongly recommended but it is limited in Uganda. Data on the practice of HH and the incidence of HAIs is sparse in resource-limited settings. We conducted a quasi-experimental study to evaluate HH practices of health care providers (HCPs) utilizing locally made ABHR and the incidence of HAIs.MethodsHH compliance among HCPs and the incidence of HAIs were assessed at Mbale Regional Referral Hospital, a teaching hospital in rural Uganda. Inpatients from the obstetrics/gynecology (OBGYN), pediatric and surgical departments were enrolled on their day of admission and followed up during their hospital stay. The baseline (pre-intervention) phase of 12-weeks was followed by a 12-week intervention phase where training for HH practice was provided to all HCPs present on the target wards and ABHR was supplied on the wards. Incidence of HAIs and or Systemic Inflammatory Response Syndrome (SIRS) was measured and compared between the baseline and intervention phases. Multivariate survival analysis was performed to identify associated variables with HAIs/SIRS.ResultsA total of 3335 patients (26.3%) were enrolled into the study from a total of 12,665 admissions on the study wards over a 24-week period. HH compliance rate significantly improved from 9.2% at baseline to 56.4% during the intervention phase (p < 0.001). The incidence of HAIs/SIRS was not significantly changed between the baseline and intervention phases (incidence rate ratio (IRR) 1.07, 95% CI: 0.79 – 1.44). However, subgroup analyses showed significant reduction in HAIs/SIRS on the pediatric and surgical departments (IRR 0.21 (95% CI: 0.10 – 0.47) and IRR 0.39 (95% CI: 0.16 – 0.92), respectively) while a significant increase in HAIs/SIRS was found on the OBGYN department (IRR 2.99 (95% CI: 1.92 – 4.66)). Multivariate survival analysis showed a significant reduction in HAIs/SIRS with ABHR use on pediatric and surgical departments (adjusted hazard ratio 0.26 (95% CI: 0.15 – 0.45)).ConclusionsTo our knowledge, this study is one of the largest studies that address HAIs in Africa. During the 24-week study period, significant improvement in HH compliance was observed by providing training and ABHR. The intervention was associated with a significant reduction in HAIs/SIRS on the pediatric and surgical departments. Further research is warranted to integrate HAIs surveillance into routine practice and to identify measures to further prevent HAIs in resource limited settings.Trial registrationClinicalTrials.gov NCT02435719, registered on 20 April, 2015 (retrospectively registered).

Highlights

  • Good hand hygiene (HH) practice is crucial to reducing healthcare associated infections (HAIs)

  • We carried out a clinical study with the following aims in Uganda: 1. To assess the baseline HH practice among health care providers (HCPs) and the impact of alcohol-based hand rub (ABHR) and training in its use on the HH practice improvement

  • The HH compliance rate rose on the pediatric wards, starting with an increased rate in week 10

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Summary

Introduction

Good hand hygiene (HH) practice is crucial to reducing healthcare associated infections (HAIs). Use of alcohol-based hand rub (ABHR) at health facilities is strongly recommended but it is limited in Uganda. Data on the practice of HH and the incidence of HAIs is sparse in resource-limited settings. We conducted a quasi-experimental study to evaluate HH practices of health care providers (HCPs) utilizing locally made ABHR and the incidence of HAIs. Hand hygiene (HH) is a basic yet critical practice to prevent healthcare associated infections (HAIs) [1]. Studies have been conducted mostly in high-income countries and little is known about HH practice and HAIs in the resource limited settings [2]. The association between HH improvement, especially with use of ABHR, and HAIs reduction has been rarely described in the resource limited setting. We carried out a clinical study with the following aims in Uganda: 1. To assess the baseline HH practice among health care providers (HCPs) and the impact of ABHR and training in its use on the HH practice improvement

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